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AMERICAN JOURNAL 0F OPTOMETRY & PHYsIoLoGIcAL Orrics Copyright 0 1988 AMERICAN ACADEMY 0? OPTOMETRY

Vol. 65, No. 8, pp. 466-463 Print.d in U.S.A.

Symposium paper

Review of Computerized Orthoptics with Specific Regard to Convergence Insufficiency

JEFFREY COOPER’

state College of Optometry, State university of New York, New York, New York

ABSTRACT

Traditional vision training or orthoptics has used line or contour targets to eliminate suppression and improve vergence performance. Manipulation of these stimuli is slow and arduous. Une stimuli require an experienced doctor/technician to Interpret responses. Recently, automated vision training using microprocessor anaglyph stimuli, i.e., random dot stereograms (RDS), has been used in an operant conditioning paradigm. This technique has improved motivation of the patient, improved reliability, and provided standardization of therapy. In addition, the utilization of RDS associated with operant conditioning has been shown to improve vergence performance and to reduce asthenopia in the convergence insufficiency patient

Key Words: vision training, orthoptics, ver gence, fusion, random dot stereograms, operant conditioning, asthenopla, convergence insufficiency, binocular vision

Orthoptic and vision training have utilized

vectograms, stereoscopes, synoptoscopes, and other types of devices to present visual stimuli binocularly. Traditional methods of changing stimulus parameters (e.g., vergence demand)

This paper is based on an oral presentation given by Dr. Cooper on December 16, 1986 at the Sympo sium of Convergence Insufficiency. The meeting was sponsored by the Binocular Vision and Perception Section at the Annual Meeting of the American Academy of Optometry, Toronto, Ontario, Canada.

Received January 5, 1988.

Optometrist, Member of Faculty, F.A.A.O.

have been slow and unreliable. Thus, reproducibility in testing and training may be questionable because doctors and technicians may alter targets at different speeds and instruct or motivate patients differently. Moreover, traditional vision training techniques require an experienced doctor/technician to interpret patients’ responses and to use that information to alter stimulus conditions in order to improve binocular response. These problems are observed in the young or noncommunicative patient.

The difficulties noted above have led some practitioners to abandon orthoptics/vision training. They may also be responsible for variability in reported success rates of orthoptics. In a similar area, visual field testing, microprocessor-controlled response-stimuli presentation has improved reliability, improved detection rate, and in general brought scientific validity into the area of in-office perimetry. Recently, research-oriented automated microprocessor- controlled methods have been reported in the field of orthoptics/vision training.

Cooper and Feldma& demonstrated that RDS presented in an operant conditioning paradigm could be used to improve stereoscopic responses in young children. In their study, young children were tested with a Titmus stereo test, a Random dot E test, and with a RDS test in an operant conditioning paradigm. The RDS test used by Cooper and Feldman required the patient to wear Polaroid glasses while looking at a screen, and to push a button which contained a visual two-dimensional pattern that matched the one projected on the screen. The RDS was projected with a stereoscopic square one-hall of the time or with a RDS that lacked disparity (flat fusion stimulus) the other one-half of the time. Correct responses were reinforced, whereas incorrect responses were not. If the child could not perceive the stereo RDS, monocular (brightness con-

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